My primary career goals related to this award are: 1) to pursue a program of investigator-initiated, hypothesis driven, high quality patient-oriented research in the specialty of digestive diseases, 2) to mentor young clinicians, with little or no research experience, in their career development as patient-oriented researchers, 3) to continue to mentor and collaborate with other clinical researchers who are beyond the entry level as clinical investigators, and 4) to contribute to career development of GI fellows who are funded on an NIH GI Training Grant. Three research studies support this research and mentoring proposal. These are collaborative research studies currently funded by this K24, the CURE Core Grant, and industry (for PPI's). The first is "Secondary Prevention of Barrett's Epithelium: Pathogenesis, Risk Factors, and Outcomes of Medical or Surgical Therapy". The principle hypothesis is that medical therapy will be more efficacious and cost effective than laparoscopic fundoplication as secondary prevention in recurrence of Barrett's epithelium. The second is "Development of Risk Scoring Instruments to Predict Outcomes and Probable Bleeding Sites in Patients with Severe Hematochezia". The primary hypothesis is that a scoring system developed from analysis of large CURE databases of patients with severe hematochezia and based upon clinical variables on presentation can predict outcomes (such as rebleeding and need for endoscopic hemostasis or surgery), and help identify the subgroup of patients most likely to benefit from urgent, sedated colonoscopy. This prospective data collection was funded by recently completed NIH grants. The third study is a feasibility study entitled "Prophylactic Banding or Propranolol to Prevent First Variceal Hemorrhage". The principle hypothesis is that initial failure of medical therapy (as monitored clinically and by hepatic venous pressure gradient) will be significantly higher and less cost effective than band ligation of varices (as monitored clinically and by endoscopy) in reducing the potential risk of first variceal hemorrhage. The mentoring of young investigators is now through structured masters degree programs and features didactic courses in biostatistics, seminars in study design, and other instruction in data management, form design for prospective trials, and protocol writing. Mentoring emphasis will be placed on planning, designing, and conducting actual prospective randomized studies. This award will continue to enhance the applicant's research productivity and provide skilled mentoring for young investigators, so they can become independent patient-oriented investigators in digestive diseases.